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Published on: September 15, 2023
Preoperative renal dysfunction and mortality after off-pump coronary artery bypass grafting in Japanese
Takeshi Kinoshita1, Tohru Asai, Yoshitaka Murakami
1Division of Cardiovascular Surgery, Shiga University of Medical Science, Otsu, Japan. kinotake@belle.shiga-med.ac.jp
Insights
Renal dysfunction in Japanese patients undergoing off-pump coronary artery bypass grafting (CABG) did not significantly impact 30-day mortality. However, reduced glomerular filtration rate (GFR) independently predicted worse long-term survival after CABG.
Area of Science:
- Cardiovascular Surgery
- Nephrology
- Outcomes Research
Background:
- Renal dysfunction is a growing concern in patients undergoing cardiovascular procedures.
- Assessing the impact of renal function on outcomes after coronary artery bypass grafting (CABG) is crucial.
Purpose of the Study:
- To compare hospital outcomes and long-term survival in Japanese patients with and without renal dysfunction undergoing isolated off-pump CABG.
- To determine the risk of renal dysfunction on survival following isolated off-pump CABG.
Main Methods:
- Retrospective analysis of 605 Japanese patients who underwent isolated off-pump CABG.
- Patients were stratified based on glomerular filtration rate (GFR) into <30, 30-60, and >60 ml/min/1.73 m².
- Multivariate Cox regression analysis was used to identify risk factors for mortality.
Main Results:
- 30-day mortality showed no significant difference across GFR groups (P=0.173).
- Five-year survival free from overall death was significantly lower in patients with lower GFR (<30: 77%, 30-60: 82%, >60: 93%; P=0.002).
- Lower GFR was an independent predictor of both overall death (HR 0.82) and cardiovascular death (HR 0.70).
Conclusions:
- Off-pump CABG demonstrates acceptable short-term outcomes even in patients with renal dysfunction.
- Preoperative renal dysfunction is a significant independent risk factor for long-term mortality after isolated off-pump CABG in Japanese patients.
Background:
The purpose of this study was to compare hospital outcomes and long-term survival in Japanese patients with or without renal dysfunction and to estimate the risk of renal dysfunction for survival after isolated off-pump coronary bypass grafting (CABG).
Methods And Results:
Among 661 consecutive Japanese patients undergoing isolated CABG (656 by the off-pump technique), after exclusion of 51 patients managed with chronic dialysis and 5 patients being revascularized using cardiopulmonary bypass, data from 605 patients were included in the present study. The 30-day mortality was 2.7%, 2.5%, and 0.7% in patients with a glomerular filtration rate (GFR) <30, 30-60, and >60 ml . min(-1) . 1.73 m(-2) (P=0.173). Mean follow-up period was 3.4+/-1.8 years. The 5-year survival free from overall death was 77%, 82%, and 93% in patients with a GFR <30, 30-60, and >60 ml . min(-1) . 1.73 m(-2) (P=0.002). Similarly, the 5-year survival free from cardiovascular death was 82%, 86%, and 97%, respectively (P=0.001). Multivariate Cox model identified GFR as a risk factor of overall death (hazard ratio, 0.82 per 10-ml . min(-1) . 1.73 m(-2) increase, 95% confidence interval, 0.70-0.95, P=0.008) and cardiovascular death (hazard ratio, 0.70 per 10-ml . min(-1) . 1.73 m(-2) increase, 95% confidence interval, 0.57-0.85, P=0.001).
Conclusions:
Off-pump CABG has a relatively low 30-day mortality in patients with renal dysfunction, but preoperative renal dysfunction is an independent risk factor of long-term survival after isolated off-pump CABG in Japanese patients.
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